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NPI Code Detail

MEDICARE: DR. JORDAN BOEKHOUT D.C.

MEDICARE: DR. JORDAN BOEKHOUT D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor6308MN

General Provider Information

NPI Number : 1184169005
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JORDAN BOEKHOUT D.C.
Provider Business Mailing Address
First Line : 4632 85TH AVE N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-1957
Country : US
Telephone Number : 763-494-4900
Fax Number : 763-494-4902
Provider Business Practice Location Address
First Line : 4632 85TH AVE N
Second Line :
City : BROOKLYN PARK
State : MN
Zip : 55443-1957
Country : US
Telephone Number : 763-494-4900
Fax Number : 763-494-4902
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2017
Last Update Date : 06/03/2021

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